DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO. APPLICATION FOR ONE/TWO/THREE DAY PERMIT OR SPECIAL SALES LICENSE. If you have any

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INSTRUCTIONS FOR COMPLETING DBPR ABT- 6003 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR ONE/TWO/ THREE DAY PERMIT OR SPE CIAL SALES LICENSE If you have any que stion s or need assistance in completing this appli cation , plea se c ontact the Division of Alcoholi c Beverage s & Toba ccs (AB&T) local district office. Plea se s ubmit your comple ted appli cation to your local district office at lea st seven (7) days prior to the first date of the event to insure the permit is issued by the event date. This appli cation may be submitted by mail , throug h appoin tment, or it can be droppe d off. A District Off ice Address and Con tact Information S hee t can be foun d on AB&Ts pag e of the DBPR web site at the link provide d belo w. Local ABT Licensing Offices This appl ication is used for obtaining a One, Two, Three Day Permit to sell alcoholic beverage s for consumption on the r epo rted premises only. A special sales license may also be obtained by the use of this appl ication for the sale of alcoholic beverage s for a period of up to three days. This license doe s not permit the sale of alcoholic beverage s for consumption on the premises and only allows package sales in the manufacturers original sealed containers. GENERAL INSTRUCTIONS Submitting Your Application The Division of Alcoholic Beverage s and Tobacco, Bureau of Licensing, accepts appl ications for one, two, and three day events and special sales licenses. Please complete all r equ ired information. All que stions must be answered fully and truthfully. You must provide an origina l appl ication and suppo rting documentation that may be requ ired by the local authorities. All signa tures must be original. Contact Pers on All communications rega rding y our application will be sent to the appl icant at the mail ing or email add ress provided . However, if you would like for us to communicate with someone other than the applicant rega rding your app lication, please provide the name and contact information for that person in the Permit or License Information section. Your named contact person will be permitted to make c hange s to the application pape rwork on y our behal f and we will communicate directly with them regarding any appl ication issues or deficiencies. You will not be copied by the division with the corresponden ce. APPLICATION REQUIREMENTS AND INSTRUCTIONS FOR COMPLETING THIS APPLICATION Florida Law for One/Two/Three Day Perm it Per Florida Statute 561 .422, upo n the filing of an application and payment of a fee of $25 per perm it, the division may issue a permit authorizing a bona -fide non -profit civic organ ization to sell alcohol ic beverage s for consumption on premises only for a period not to exceed 3 days for a single event, subject to any state law or municipal or coun ty ordinan ce regu lating the time for selling such beverage s. Any such c ivic organi zation may be issued only three such permits per calenda r year except in those coun ties or cities with special acts governing the number of permits allowed. Any bona -fide non -profit civic organi zation permitted unde r this section may purchase alcoholic beverages from a distributor or vendo r licensed unde r the beverage law. The appl icable statute can be foun d at: Temporary Permit (ODP) Special Acts The following cities have special acts which permit the issuance of more than three permits per calenda r year if the event is held in a specific geog raph ical area: City of St. Petersburg; City of Tallaha ssee; City of Lee sburg; City of Eustis; City of Tavares; City of Moun t Dora; City of Clearwater. The special acts may be viewed at: Temporary Permit Special Act Information All sections of the appl ication must be completed except the section titled Affidavit for Special S ales License. Registration of Legal Entity or P roof of Non-Profit Status All corporations, domestic or foreign and limited liability companies seeking this permit are required to be registered with the Florida Secretary of State, Division of Corporations, as non -profit and the status of the registered entity must be active. Organi zations NOT incorporated must submit one of the following: a letter 1 Auth: 61A-5.0013, FAC

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outlining the purpose and the goa ls of the event and who will ben efit from the events profits; organi zati s National , State, or Local charter; organizati s by-laws, 501(c)3 r egistration , or Minutes of Meeting. If you have not alread y registered, you will nee d to contact the Depa rtment of State at (850 ) 488 -900 0 or www.sunbiz.org for further information. Y our appl ication will be considered incomplete withou t this active registration or proof of non- profit status. Sales Tax Cer tification to be completed by the Florida Depa rtment of Revenu e. Please take this application form to the Department of Reve nue for their app roval. The add ress for the office serving y our area of interest can be found at Local ABT Licensing Of fices. Applications must be submitted within 90 days of receiving this app roval. Zoning Approval This section only applies to applications for a One, Two, Three Day Perm it. The city or coun ty zoning authority in which the event or special sale will be held executes zoning app roval. Please check with your local authority for their requ irements. The add ress for the zoning office serving y our area of interest can be foun d at Local ABT Licensing Offices . Appl ications must be submitted within 180 days of receiving this app roval. Sketch of Prem ises A complete sketch of the premises, drawn in ink or computer gene rated ( letter size) which include s all permanent walls, doo rs, windows, coun ters, label ing each r oom and area. Include any outside areas where alcoho lic beverage s will be sold, consumed, or served. Due to the difficulty of sca nning, no blueprints are acce pted. When the event of the non profit organ ization is being held at a location that is alread y licensed for the sale of alcoho lic beverage s, a sketch of the entire premises must be submitted. If the event does not include the entire premises, the sketch must iden tify the area of the licensed premises where the event is to be held and must be a sepa rate room or enclosure. The attestation include d with this app lication must have the original signature of the permanen t license holder and must be submitted by the non-profit group as part of the completed application. Affidavit of Applicant for One, Two , Three Day Perm it Rea d and sign in the presence of a notary. The affidavit must be signe d by an officer of the Non -Profit Civic Organi zation; or in the case of a church, synagogue , schoo l, or fraternity/sorority, the signa ture of an authorized representative of the church, synago gue, schoo l, or fraternity/sorority. There are severa l important points you should be aware of: 1. The legal drinking age is 21. Please ensure that no one unde r 21 y ear s of age is served an alcoholic beverage or allowed to consume alcohol ic beverage s. 2. The purpose of this permit is to provide your non -profit organ ization with a permit to sell alcohol ic beverage s to gene rate funds for your civic or charitable cause. 3. Your organization, as the perm it holder, is the ONLY entity that may rece ive any of the profits from the sale of alcoholic bevera ges on this perm it. You must have res ponsible mem bers of your organization at the alcoholic beve rage sales location at all times . Your eve nt CANNOT involve the SHARING OF ANY PROFITS OR RECEIPTS, or a DONATION to your cause if you obtain a temporar y perm it. Participation in this prac tice subjects your organization to jeopardy and denial of future alcoholic bevera ge perm its. 4. All records of alcohol ic beverage purchases and sales must be retained for examination by the Division of Alcohol ic Beverage s and Tobacco personne l. 5. No One, Two, Three Day Permit will be issued to any organization in c onne ction with any type of gambling activity, i.e. Casino Night, Las Vega s Night, Monte Carlo Night, etc. 6. If your event is cancelled due to acts of nature, and you plan to resc hedule, you need to notify the division within 14 days of the cancellation so that you will be eligible for re- issuance of the perm it at no fee to you. 7. The Division of Alcoholi c Beve rages and Tobacco wil l issue One, Two, Three Day Permits to Coll ege fraternities and sororities only when the follow ing conditions are met: a) The permit is being reque sted for an event that clearly has a designa ted charitable or civic purpose, such as a charity fund raiser. The Division must have written app roval for the holding of such event from a designa ted b) 2 Auth: 61A-5.0013, FAC

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school official with responsibility over fraternity or sorority activities, such as the organ izati s advisor, or the director of student activities or his/her designe e. The Division must receive a specific written outline from the fraternity or sorority as to where the event will be held, how entry into the event will be controlled so as to prevent the attendan ce of minors, and how control of the event will be maintained by the fraternity or sorority to prevent such matters as excess consumption, imprope r distribution of alcohol ic beverage s and the like. c) Florida Law for Special Sales License Florida Statute 561 .20(12)(a), upo n the filing of an appli cation and payment of a fee of $25 per permit, the division may issue a license authorizing the sale of alcohol ic beverage s in sealed containers only, for a period not to exceed 3 days. This license is issued only for the purpose of authorizing a sale pursuan t to: levy and execution; ban kruptcy sale; a sale by an insurance c ompany in possession of alcohol ic beverage s; a sale r esulting from a license suspension or revocation; a sale of damaged good s by a common carrier; a sale by a bon a fide wine collector; or a sale pursuan t to part V of chap ter 679 Florida Law for Special Sales License Registration of Legal Entity All corporations, domestic or foreign; gene ral partnerships; limited liability companies; limited liabil ity partnership s; and limited partnerships are r equired to be registered with the Florida Depa rtment of State, Division of Corporations. If you have not alread y registered, you will nee d to contact the Depa rtment of State at (850 ) 488- 900 0 or www.sunb iz.org for further information. Your app lication will be considered incomplete withou t this active registration. Sales Tax Cer tification to be completed by the Florida Depa rtment of Revenu e. Please take this application form to the Department of Reve nue for their app roval. The add ress for the office serving y our area of interest can be found at Local ABT Licensing Offices Applications must be submitted within 90 days of receiving this app roval. Affidavit of Applicant for Special Sales License Rea d and sign in the presence of a notary. The affidavit must be signe d by the individual appl icant, each partner of a gene ral partnership, a gene ral partner of a gene ral partnership of a limited partnership, a managing member, manager, or officer of a limited liability company, each partner of a limited liabil ity partnership, or one of the officers of a corporate app licant. All signa tures must be original. APPLICATION CHECKLIST 3 Auth: 61A-5.0013, FAC TRANSACTION APPLICATION REQUIREMENTS One/Two/ Three Day P erm it Complete DBPR ABT-6003 Division of Alcohol ic Beverage s and Tobacco A ppl ication for One/Two/Three Day Permit or Special Sales License. You may app ly for multiple event dates. Pay $25 fee for each event (make c heck payable to the Division of Alcohol ic Beverages and Toba cco). College fraternities and sororities must meet certain cond itions which are outlined in the application instructions and requ irements. Special Sales License Complete DBPR ABT-600 3 Division of Alcohol ic Beverage s and Tobacco A ppl ication for One/Two/Three Day Permits or Special Sales License. Pay $25 fee (make check payable to the Division of Alcoho lic Beverage s and Tobacco).

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DBPR ABT-600 3 Division of Alcoholic Bevera ges and Tobacco Appli cation for One/Two/Three Day P erm it or Special Sales License STATE OF FLORIDA DEPARTMENT OF BUSINESS AND P ROFESSIONAL REGULATION DBPR Form ABT- 6003 Rev ised 08/2013 If you have any que stion s or need assistance in completing this appli cation , plea se c ontact the Division of Alcoholi c Beverage s & Toba ccs (AB&T) local district office. Plea se s ubmit your comple ted appli cation to your local district office at lea st (7) days prior to the first date of the event to insure the permit is issued by the event date. This appli cation may be submitted by mail , or it can be droppe d off. A District Office Address and Con tact Information S hee t can be foun d on AB& Ts pag e of the DBPR web site at the link provide d belo w. Local ABT Licensing Offices 1 Auth: 61A-5.0013, FAC ABT District Office Rece ived Date St amp SECTION 2 PERMIT or LICENSE INFORMATION If the appl icant is a corporation or other lega l entity, enter the name and the document number as registered with the Florida Depa rtment of State Division of Corporations on the line below. FEIN Number Business Telephon e Number E-Mail A ddress (Optiona l) Full Name of Applicant(s): (This is the name the permit or license will be issued in) Depa rtment of State Document # Business Name (D/B/A) or Name of Event Location of Event (Street and Number) City Coun ty State FL Zip Code Mailing Address (Street or P.O. Box) City State Zip Code Contact Pers on – This section is optional, see application instructions for details Con tact Person Telephon e Number ext. Email Address (Optiona l) Mailing Address (Street or P.O. Box) City State Zip Code Date(s) Permit Desired SECTION 1 — CHECK TRANSACTION REQUESTED Transaction Type: One/Two/Three Day Permit Special S ales License

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Note: College fraternities and sororities must meet certain additional conditions which can be found in the application instructions and requirements. 2 Auth: 61A-5.0013, FAC SECTION 4 – ZONING TO BE COMPLETED BY THE ZONING AUTHORITY GOVERNING THE EVENT LOCATION Location of Event (Street and Number) City Coun ty The location complies with z oning requ irements for the temporary sale of alcoholic beverages pursuant to this app lication for a One/Two/Three Day Permit. Signed Date Title SECTION 3 SALES TAX TO BE COMPLETED BY THE DEPARTMENT OF REVENUE Full Nam e of Applicant Organization Error! Refere nce source not found. The named appl icant for a license/permit has complied with the Florida Statutes concerning registration for Sales and Use Tax and has agreed to pay any applicable taxes due. Signed Date Title Depa rtment of Revenu e Stamp:

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3 Auth: 61A-5.0013, FAC SECTION 5 DESCRIPTIO N OF PREMISES TO BE LICENSED AB&T AUTHORIZED SIGNATURE REQUIRED Business Name (D/B/A) or Name of Event Neatly draw a floor plan of the premises in ink, including sidewalks and other outside areas which are contiguou s to the premises, walls, doors, coun ters, sales areas, storage areas, restrooms, bar locations and any other specific areas which are part of the premises where the event will be held. A multi-story building where the entire building is to be licensed must show the details of each floor.

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5 Auth: 61A-5.0013, FAC SECTION 7 – AFFIDAVIT OF APPLICANT FOR SPE CIAL SALES LICENSE NOTARIZATIO N REQUIRED Full Nam e of Applicant Organization “I, the unde rsigne d indi vidual , or if a corporation, its authorized representative, hereby swear or affirm that I am duly authorized to make the above and foregoing appl ication for a special sales license which authorizes the sale of a lcohol ic beverage s for period of up to three (3) days. I unde rstand this license doe s not permit the sale of alcoho lic beverage s for consumption on the premises and only allows package sales in sealed containers and acknowledg e that the location may be inspected and searched during the hou rs that the special sale is being condu cted withou t a search warrant by authorized agen ts or employees of the Division of Alcohol ic Beverage s and Toba cco, the S heriff, his Depu ties, and Police Officers for purposes of determinin g compliance with the beverage s laws. I swear under oath or affirmation unde r pena lty of perjury as provided for in Sections 559 .791 , 562.45, and 837 .06, that the forego ing information is true to the best of my knowledg e and that no other person or entity except as indicated herein has an interest in the special sales license and that all of the above listed persons or entities meet the qualifications necessary to hold this special sales license.” STATE OF COUNTY OF APP LICANT/ AUTHORIZED REPRESENTATIVE NAME APP LICANT/ AUTHORIZED REPRESENTATIVE SIGNATURE The foregoing was ( ) Sworn to and S ubscribed before me this Day of , 20 , By who is ( ) persona lly known to me (print name(s) of person making statement) OR ( ) who produ ced _ _as iden tification. Commission Expires: Notary Publ ic

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ATTESTATION This form is to be completed by the alcoholic beverage license holder ONLY when the event of the non profit organization is being held at a location that is licensed by the Division of Alcoholic Beverages & Tobacco for the sale of alcoho lic beverage s. Note: This attestation must have the original signa ture of the alcoholic bev erage license holder (only persons on file with the division may sign) and must be submitted by the non-profit group along with the app lication for the One/Two/Three Day Permit. I M P O R T A N T A One /Two/Three Day permit is being reque sted for an event to be held on your licensed premises. During the event, no sales or service of alcoho lic beverages may be made und er your alcoholic beverage license in the area identified for use by the non-profit organization. Failure to comply will result in administrative charges being filed against your license. Signa ture of Licensee: Date: 6 Auth: 61A-5.0013, FAC Licensee: Business Name (DBA): License #: Series of Permanen t License: Type: Con tact Person Telephon e Number ext. E-Mail A ddress (Optiona l) Name of Non -Profit Group: Date(s) of Event

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